The clinically-integrated randomized trial: Proposed novel method for conducting large trials at low cost Journal Article
| Authors: | Vickers, A. J.; Scardino, P. T. |
| Article Title: | The clinically-integrated randomized trial: Proposed novel method for conducting large trials at low cost |
| Abstract: | Introduction: Randomized controlled trials provide the best method of determining which of two comparable treatments is preferable. Unfortunately, contemporary randomized trials have become increasingly expensive, complex and burdened by regulation, so much so that many trials are of doubtful feasibility. Discussion: Here we present a proposal for a novel, streamlined approach to randomized trials: the "clinically-integrated randomized trial". The key aspect of our methodology is that the clinical experience of the patient and doctor is virtually indistinguishable whether or not the patient is randomized, primarily because outcome data are obtained from routine clinical data, or from short, web-based questionnaires. Integration of a randomized trial into routine clinical practice also implies that there should be an attempt to randomize every patient, a corollary of which is that eligibility criteria are minimized. The similar clinical experience of patients on- and off-study also entails that the marginal cost of putting an additional patient on trial is negligible. We propose examples of how the clinically-integrated randomized trial might be applied in four distinct areas of medicine: comparisons of surgical techniques, "me too" drugs, rare diseases and lifestyle interventions. Barriers to implementing clinically-integrated randomized trials are discussed. Conclusion: The proposed clinically-integrated randomized trial may allow us to enlarge dramatically the number of clinical questions that can be addressed by randomization. © 2009 Vickers and Scardino; licensee BioMed Central Ltd. |
| Keywords: | treatment outcome; patient selection; outcome assessment; methodology; clinical practice; randomized controlled trial; internet; randomized controlled trials as topic; motivation; editorial; information processing; questionnaires; prostate cancer; prostatic neoplasms; financial management; economics; questionnaire; patient participation; feasibility study; clinical study; prostatectomy; prostate tumor; medical record; intermethod comparison; randomization; lifestyle modification; risk reduction; research support as topic; cost benefit analysis; risk reduction behavior; sample size; rare disease; medical records; rare diseases |
| Journal Title: | Trials |
| Volume: | 10 |
| ISSN: | 1745-6215 |
| Publisher: | Biomed Central Ltd |
| Date Published: | 2009-03-05 |
| Start Page: | 14 |
| Language: | English |
| DOI: | 10.1186/1745-6215-10-14 |
| PUBMED: | 19265515 |
| PROVIDER: | scopus |
| PMCID: | PMC2656491 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 7" - "Export Date: 30 November 2010" - "Art. No.: 14" - "Source: Scopus" |
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